Enroll a Child

Parent/Guardian's First Name:
Parent/Guardian's Last Name:
Parent/Guardian's Relationship to Child:

Spanish Speaking?:
Parent/Guardian's Mobile Phone:

Child's Date of Birth:
Child's Gender:
Child's Ethnicity:
Does your child have a parent or loved one who has ever been incarcerated, even for a day?:
How did you hear about us?:
Does your child see a counselor or therapist?: